Beyond rebuilding its credibility after the scientists' resignations, and convincing taxpayers that it can disburse funds fairly, the agency must grapple with other issues: a state audit; a coming legislative session in which all options, including de-funding, may be on the table; and, critically, how the cancer agency should spend its money if it is to show progress in curing and reducing the effects of the disease.

In 2007, more than 61 percent of the state's voters elected to create the cancer institute, authorizing the state to sell bonds providing it with $3 billion over 10 years.

The agency's chief goal was to fund ground- breaking cancer research in Texas. It also would direct some of those funds toward prevention and the commercialization of existing drugs.

Review panel ignored

The agency hired Gilman, a Nobel laureate, to establish a process to distribute research funds based on scientific merit. Gilman brought another Nobel laureate, Dr. Phillip Sharp, on board to lead a committee of scientific reviewers.

Now both are gone, along with the seven chief reviewers the pair recruited.

"A friend of mine experienced in these matters told me this is the way it always works when you put a large amount of money on the table," said Gilman. "The vultures lie low for a couple years, figuring out how the system works. Then they come in for the feast. The M.D. Anderson grant was the first course of that feast."

The agency has vowed to reform the approval of commercial grants. It also said it would re-review the M.D. Anderson grant, which has not been funded.

The oversight committee wrote in a letter to the Houston Chronicle that it was "regrettable" that Gilman and Sharp had become uncomfortable with the board's leadership.

"We, the Oversight Committee, hold the steward­ship of public trust as our highest obligation and it will remain the cornerstone of how CPRIT reviews and awards grants," the committee members wrote.

Audit report awaited

In addition to rebuilding its scientific review committee during the coming months, the cancer initiative also must respond to a state audit. According to Bill Gimson, executive director, the periodic audit is coming at an opportune time as the agency reforms its commercial grant process.

The state auditor's office is expected to issue its final report and recommendations in late January, Gimson said. That will come as a new legislative session begins, and Branch said he'll be reading the report closely. Other legislators will, as well.

State Rep. Garnet Coleman, who abstained from voting for the bill creating the cancer initiative as a member of the Public Health Committee, said the Legislature needs to take a leadership role in reforming the agency.

The law creating it, Coleman said, was "a very poorly written bill, badly constructed, lacking appropriate oversight, giving no indication how it will lead to cures for cancer."

The Houston Democrat said he will file legislation this session to increase the amount of money that goes toward prevention, and to create rules that will prevent reoccurrences of the kinds of problems that arose with the M.D. Anderson grant.

Despite continuing pressure on the state budget, legislators don't yet seem inclined to reduce the cancer agency's funding. Doing so would be a mistake, Gimson said.

"Now is not the time to stop this investment," he said. "My hope is that everyone realizes the commitment that Texas made was such a bold move, that we're investing at a time when every other state is stepping back their academic and commercial research commitment."

Interest seems high, however, in changing the way the agency spends its money.

The law limits the funds spent on prevention efforts to 10 percent of the annual $300 million budget. But during a series of meetings around the state this summer, hundreds of stakeholders said more should be spent on prevention."

Texans want results

At least one person associated with the cancer initiative would like to see more money devoted to commercialization to seed the efforts of businesses to bring cancer drugs into the marketplace.

In a May 2 email to agency officials obtained by the Chronicle, one of its commercial reviewers, health care investor Robert Ullrich, wrote, "Overall, I see commercialization effectively utilizing approximately 40 to 45 percent of each year's CPRIT funds for the near to immediate term."

More funds spent on prevention and commercialization would reduce funds spent on basic research aimed at curing cancer.

However, agency leaders are mindful of impatience among Texans. Three years after its first grants, the agency's most notable success is the recruitment of 45 excellent scientists to Texas. Its basic research is unlikely to have definitive successes in the next five to seven years, after which its initial funding will end.

"These types of investments do take time," Gimson said. "So we're exploring where we could have an earlier impact. We will always fund basic research, but we may look at trying to enhance our funding of translational and clinical research."